Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

ATI: PHARM 2 - (Drug Classes) > Coagulation Modifier Drugs > Flashcards

Coagulation Modifier Drugs Flashcards

1
Q

Alteplase (tissue plasminogen activator, t-Pa)

Chemical Classification

A

Tissue plasminogen activator (TPA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Alteplase (tissue plasminogen activator t-Pa)

Mechanism of Action

A

Produces fibrin conversion of plasminogen to plasmin; able to bind to fibrin, convert plasminogen in thrombus to plasmin, which leads to local fibrinolysis, limited systemic proteolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Alteplase (tissue plasminogen activator t-Pa)

Uses

A

Lysis of obstructing thrombi associated with acute MI, ischemic conditions that require thrombolysis (i.e., PE, unclotting arteriovenous shunts, acute ischemic CVA), central venous catheter occlusion (Cathflo)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Alteplase (tissue plasminogen activator, t-Pa)

Contraindications

A

Active internal bleeding, history of CVA, severe uncontrolled hypertension, intracranial/intraspinal surgery/trauma (within 3 mo), aneurysm, brain tumor, platelets 1.7 or PR >15 sec, arteriovenous malformation, subarachnoid hemorrhage, intracranial hemorrhage, uncontrolled hypertension, seizure at onset of stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Alteplase (tissue plasminogen activator, t-Pa)

Side Effect

A

CV: SINUS BRADYCARDIA, CHOLESTEROL MICROEMBOLIZATION, VENTRICULAR TACHYCARDIA, ACCELERATED IDIOVENTRICULAR RHYTHM, BRADYCARDIA, RECURRENT ISCHEMIC STROKE, hypotension
EENT: OROLINGUAL ANGIOEDEMA
INTEG: urticaria, rash
SYST: GI, GU, INTRACRANIAL, RETROPERITONEAL BLEEDING, Surface Bleeding, ANAPHYLAXIS, fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Alteplase (tissue plasminogen activator, t-Pa)

Nursing Considerations

A

ASSESS:

  • Treatment is not recommended for patients with acute ischemic stroke >3hr after symptom onset or with minor neurologic deficits or rapidly improving symptoms
  • VS, BP, pulse, respirations, neurologic signs, temp at least q4hr; temp >104 degree F (40 degree C) indicates internal bleeding; monitor rhythm closely; ventricular dysrhythmias may occur with hyperfusion; monitor heart, breath sounds, neurologic status, peripheral pulses; assess neurologic status, neurologic change may indicate intracranial bleeding; those with severe neurologic deficit (NIH SS>22) at presentation have increased risk of hemorrhage
  • FOR BLEEDING during 1st hour of treatment and 24hr after procedure: hematuria, hematemesis, bleeding from mucous membranes, epistaxis, ecchymosis; guaiac all body fluids, stools; do not use 150mg or more total dose because intracranial bleeding may occur
  • HYPERSENSITIVITY: fever, rash, itching, chills, facial swelling, dyspnea, notify prescriber immediately; stop product, keep resuscitative equipment nearby; mild reaction may be treated with antihistamines
  • Previous allergic reactions or streptococcal infection; alteplase may be less effective
  • BLOOD STUDIES (Hct, PLATELETS, PTT, PT, TT, APTT) BEFORE STARTING THERAPY; PT or APTT MUST BE LESS THAN 2x CONTROL BEFORE STARTING THERAPY TT OR PT q3-4hr DURING TREATMENT
  • MI: ECG CONTINUOUSLY, CARDIAC ENZYMES, RADIONUCLIDE MYOCARDIAL SCANNING/CORONARY ANGIOGRAPHY; CHEST PAIN INTENSITY, CHARACTER; MONITOR THOSE WITH MAJOR EARLY INFARCT SIGNS ON CT SCAN WITH SUBSTANTIAL EDEMA, MASS EFFECT, MIDLINE SHIFT
  • PE: PULSE, BP, ABGs, RATE/RHYTHM of RESPIRATIONS
  • OCCLUSION: have patient exhale then hold breath when connecting/disconnecting syringe to prevent air embolism
  • CHOLESTEROL EMBOLISM: purple toe syndrome, acute renal failure, gangrenous digits, hypertension, livedo reticularis, pancreatitis, MI, cerebral infarction, spinal cord infarction, retinal artery occlusion, bowel infarction, rhabdomyolysis

PERFORM/PROVIDE:

  • Avoidance of invasive procedures, inj, rectal temp
  • Pressure for 30 sec to minor bleeding sites; 30 min to sites of atrial puncture followed by pressure dressing; inform prescriber if this does not attain hemostasis; apply pressure dressing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Aspirin

Functional Classification

A

Nonopioid analgesic, non-steroidal anti-inflammatory, antipyretic, antiplatelet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Aspirin

Chemical Classification

A

Salicylate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Aspirin

Mechanism of Action

A

Blocks pain impulses in CNS, reduces inflammation by inhibition of prostaglandin synthesis; antipyretic action results from vasodilation of peripheral vessels; decreases platelet aggregation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Aspirin

Uses

A

Mild to moderate pain or fever including RA, osteoarthritis, thromboembolic disorders; TIAs, rheumatic fever, post MI, prophylaxis of MI, ischemic stroke, angina, acute MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Aspirin

Contraindications

A

Pregnancy (D) 3rd trimester, breastfeeding, children <12yr, children with flulike symptoms, hypersensitivity to salicylates, tartrazine (FDC yellow dye #5), GI bleeding disorders, vit K deficiency, peptic ulcer, acute bronchospasm, agranulocytosis, increased intracranial pressure intracranial bleeding, nasal polyps, urticaria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Aspirin

Side Effects

A

CNS: stimulation, drowsiness, dizziness, confusion, SEIZURES, headache, flushing, hallucinations, COMA
CV: rapid pulse, pulmonary edema
EENT: tinnitus, hearing loss
ENDO: hypoglycemia, hyponatremia, hypokalemia
GI: Nausea, Vomiting, GI BLEEDING, diarrhea, heartburn, anorexia, HEPATITIS
HEMA: THROMBOCYTOPENIA, AGRANULOCYTOSIS, LEUKOPENIA, NEUTROPENIA, HEMOLYTIC ANEMIA, increased PT, aPTT, bleeding time
INTEG: Rash, urticaria, bruising
RESP: wheezing, hyperpnea
SYST: REYE’S SYNDROME (CHILDREN), ANAPHYLAXIS, LARYNGEAL EDEMA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Aspirin

Nursing Considerations

A

ASSESS:

  • PAIN: character, location, intensity; ROM before and 1 hr after administration
  • FEVER: temp before and 1 hr after administration
  • Hepatic studies: AST, ALT, bilirubin, creatinine if patient is receiving long-term therapy
  • Renal studies: BUN, urine creatinine; I&O ratio; decreasing output may indicate renal failure (long-term therapy)
  • Blood studies: CBC, Hct, Hgb, PT if patient is receiving long-term therapy
  • HEPATOTOXICITY: dark urine, clay-colored stools, yellowing of skin, sclera, itching, abdominal pain, fever, diarrhea if patient is receiving long-term therapy
  • ALLERGIC REACTIONS: rash, urticaria; if these occur, product may have to be discontinued; patients with asthma, nasal polyps, allergies: severe allergic reaction may occur
  • OTOTOXICITY: tinnitus, ringing, roaring in ears; audiometric testing needed before, after long-term therapy
  • SALICYLATE LEVEL: therapeutic level 150-300mcg/ml for chronic inflammation
  • Edema in feet, ankles, legs
  • Product history; many product interactions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Aspirin

Overdose Treatment

A

Lavage, activated charcoal, monitor electrolytes, VS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Clopidogrel (Plavix)

Functional Classification

A

Platelet aggregation inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Clopidogrel (Plavix)

Chemical Classification

A

Thienopyridine derivative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Clopidogrel (Plavix)

Mechanism of Action

A

Inhibits ADP-induced platelet aggregation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Clopidogrel (Plavix)

Uses

A

Reducing the risk of stroke, MI, vascular death, peripheral arterial disease in high-risk patients, acute coronary syndrome, transient ischemic attack (TIA), unstable angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Clopidogrel (Plavix)

Contraindications

A

hypersensitivity, active bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Clopidogrel (Plavix)

Side Effects

A

CNS: headache, dizziness, depression, syncope, hypesthesia, neuralgia
CV: edema, hypertension, chest pain
GI: nausea, vomiting, diarrhea, constipation, GI discomfort, GI BLEEDING, PANCREATITIS, HEPATIC FAILURE
GU: GLOMERULONEPHRITIS
HEMA: epistaxis, purpura, BLEEDING, NEUTROPENIA, APLASTIC ANEMIA, AGRANULOCYTOSIS, THROMBOTIC THROMBOCYTOPENIC PURPURA
INTEG: rashm pruritus, ANAPHYLAXIS
MISC: UTI, hypercholesterolemia, chest pain, fatigue, INTRACRANIAL HEMORRHAGE, TOXIC EPIDERMAL NECROLYSIS, STEVENS-JOHNSON SYNDROME, flulike syndrome
MS: arthralgia, back pain
RESP: upper respiratory tract infection, dyspnea, rhinitis, bronchitis, cough, BRONCHOSPASM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Clopidogrel (Plavix)

Nursing Considerations

A

ASSESS:

  • THROMBOTIC/ THROMBOCYTIC PURPURA, fever, thrombocytopenia, neurolytic anemia
  • Symptoms of stroke, MI during treatment
  • Hepatic studies: AST, ALT, bilirubin, creatinine (long-term therapy)
  • Blood studies: CBC, differential, Hct, Hgb, PT, cholesterol (long-term therapy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Dabigatran (Pradaxa)

Functional Classification

A

Anticoagulant-thrombin inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Dabigatran (Pradaxa)

Mechanism of Action

A

Direct thrombin inhibitor that inhibits both free and clot-bound thrombin, prevents thrombin-induced platelet aggregation and thrombus formation by preventing conversion of fibrinogen to fibrin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Dabigatran (Pradaxa)

Uses

A

Stroke/systemic embolism prophylaxis with nonvalvular atrial fibrillation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Dabigatran (Pradaxa) | Contraindications
Hypersensitivity, bleeding
26
Dabigatran (Pradaxa) | Side Effects
``` CNS: INTRACRANIAL BLEEDING CV: MYOCARDIAL INFARCTION GI: abdominal pain, dyspepsia, peptic ulcer, esophagitis, GERD, gastritis, GI BLEEDING HEMA: BLEEDING INTEG: rash, pruritus SYST: ANAPHYLAXIS (RARE) ```
27
Dabigatran (Pradaxa) | Nursing Considerations
ASSESS: - BLEEDING: blood in urine or emesis, dark tarry stools, lower back pain; caution with arterial/venous punctures, catheters, NG tubes; monitor vital signs frequently; elderly more prone to serious bleeding - THROMBOSIS/MI/EMBOLI: swelling, pain, redness, difficulty breathing, chest pain, tachypnea, cough, coughing up blood, cyanosis - POST-THROMBOTIC SYNDROME: pain, heaviness, itching/tingling, swelling, varicose veins, brownish/reddish skin discoloration, ulcers; use of ambulation, compression stockings, adequate anticoagulation can prevent this syndrome - Serum Creatinine
28
Enoxaparin (Lovenox) | Functional Classification
anticoagulant, antithrombotic
29
Enoxaparin (Lovenox) | Chemical Classification
Low-molecular-weight heparin (LMWH)
30
Enoxaparin (Lovenox) | Mechanism of Action
Binds to antithrombin III inactivating factors Xa/IIa, thereby resulting in a higher ratio of anti-factor Xa to IIa
31
Enoxaparin (Lovenox) | Uses
Prevention of DVT (inpatient or outpatinet), PE (inpatient in hip and knee replacement, abdominal surgery at risk for thrombosis; unstable angina/non-Q-wave MI
32
Enoxaparin (Lovenox) | Contraindications
Hypersensitivity to this product, benzyl alcohol, heparin, pork; active major bleeding, hemophilia, leukemia with bleeding, peptic ulcer disease, thrombocytopenic purpura, heparin-induced thrombocytopenia
33
Enoxaparin (Lovenox) | Side Effects
``` CNS: fever, confusion GI: nausea HEMA: HEMORRHAGE, HYPOCHROMIC ANEMIA, THROMBOCYTOPENIA, BLEEDING INTEG: ecchymosis, inj site hematoma META: hyperkalemia in renal failure SYST: edema, peripheral edema ```
34
Enoxaparin (Lovenox) | Nursing Considerations
ASSESS: - Blood studies (Hct/Hgb, CBC, coagulation studies, platelets, occult blood in stools), anti-factor Xa (should be checked 4 hr after inj); thrombocytopenia may occur - Renal studies: BUN/creatinine baseline and periodically - BLEEDING: gums, petechiae, ecchymosis, black tarry stools, hematuria; notify prescriber - NEUROLOGIC SYMPTOMS in patients who have received spinal anesthesia
35
Enoxaparin (Lovenox) | Overdose Treatment
Protamine SO4 1% sol; dose should equal dose of enoxaparin
36
Eptfibatide | Functional Classification
Antiplatelet agent
37
Eptifibatide | Chemical Classification
Glycoprotein IIb/IIIa inhibitor
38
Eptifibatide | Mechanism of Action
Platelet glycoprotein antagonist; this agent reversibly prevents fibrinogen, von Willebrand's factor from binding to the glycoprotein IIb/IIIa receptor, thus inhibiting platelet aggregation
39
Eptifibatide | Uses
Acute coronary syndrome including those undergoing percutaneous coronary intervention (PCI)
40
Eptifibatide | Contraindications
Hypersensitivity, active internal bleeding; history of bleeding, stroke within 2 yr; major surgery with severe trauma, severe hypertension, history of intracranial bleeding, current or planned use of another parenteral GP IIb/IIIa inhibitor, dependence on renal dialysis, coagulopathy, AV malformation, aneurysm
41
Eptifibatide | Side Effects
CV: STROKE, hypotension GU: hematuria HEMA: THROMBOCYTOPENIA SYST: BLEEDING, ANAPHYLAXIS
42
Eptifibatide | Nursing Considerations
ASSESS: - THROMBOCYTOPENIA: platelets, Hgb, Hct, creatinine, PT/APTT baseline INR within 6 hr of loading dose, daily thereafter, patients undergoing PCI should have ACT monitored; maintain APTT 50-70 sec unless PCI to be performed; during PCI, ACT should be 200-300 sec; if platelets drop <100,000mm3, obtain additional platelet counts; if thrombocytopenia is confirmed, discontinue product; draw Hct, Hgb, serum creatinine - BLEEDING: gums, bruising, ecchymosis, petechiae; from GI, GU tract, cardiac cath sites, IM inj sites PERFORM/PROVIDE: - Discontinue product prior to CABG - All medications PO if possible; avoid IM inj, all catheters
43
Fondaparinux (Arixtra) | Functional Classification
Anticoagulant, antithrombotic
44
Fondaparinux (Arixtra) | Chemical Classification
Synthetic, selective factor Xa inhibitor
45
Fondaparinux (Arixtra) | Mechanism of Action
Acts by antithrombin III (ATIII)-mediated selective inhibition of factor Xa; neutralization of factor Xa interrupts blood coagulation and inhibits thrombin formation; does not inactivate thrombin (activated factor II) or affect platelets
46
Fondaparinux (Arixtra) | Uses
Prevention/treatment of deep venous thrombosis, PE in hip and knee replacement, hip fracture or abdominal surgery
47
Fondaparinux (Arixtra) | Contraindications
Hypersensitivity to this product; hemophilia, leukemia with bleeding, peptic ulcer disease, hemorrhagic stroke, surgery, thrombocytopenic purpura, weight <30 ml/min), active major bleeding, bacterial endocarditis
48
Fondaparinux (Arixtra) | Side Effects
CNS: Fever, confusion, headache, dizziness, Insomnia GI: Nausea, Vomiting, diarrhea, dyspepsia, Constipation, increased AST, ALT GU: UTI, urinary retention HEMA: Anemia, minor bleeding, purpura, hematoma, THROMBOCYTOPENIA, MAJOR BLEEDING (INTRACRANIAL, CEREBRAL, RETROPERITONEAL HEMORRHAGE), POSTOPERATIVE HEMORRHAGE, HEPARIN-INDUCED THROMBOCYTOPENIA INTEG: increased wound drainage, bullous eruption, local reaction-Rash, pruritus, inj site bleeding META: hypokalemia OTHER: hypotension, pain, Edema
49
Fondaparinux (Arixtra) | Nursing Considerations
ASSESS: - Monitor patients who have received epidural/spinal anesthesia or lumbar puncture for neurological impairment - Blood studies (CBC, anti-Xa, Hgb/Hct, prothrombin time, platelets, occult blood in stools), thrombocytopenia may occur; if platelets <100,000/mm3, treatment should be discontinued; renal studies: BUN, creatinine - For bleeding: gums, petechiae, ecchymosis, black tarry stools, hematuria; decreased Hct, notify prescriber - For risk of hemorrhage if coadministering with other products that may cause bleeding - For hypersensitivity: rash, fever, chills; notify prescriber
50
Heparin | Functional Classification
Anticoagulant, Antithrombotic
51
Heparin | Mechanism of Action
Prevents conversion of fibrinogen to fibrin and prothrombin to thrombin by enhancing inhibitory effects of antithrombin III
52
Heparin | Uses
Prevention of deep venous thrombosis, PE, MI, open heart surgery, disseminated intravascular clotting syndrome, atrial fibrillation with emoblization, as an anticoagulant in transfusion and dialysis procedures, prevention of DVT/PE, to maintain patency of indwelling venipuncture devices; diagnosis, treatment of DIC
53
Heparin | Contraindications
hypersensitivity, hemophilia, leukemia with bleeding, peptic ulcer disease, severe thrombocytopenic purpura, severe renal/hepatic disease, blood dyscrasias, severe hypertension, subacute bacterial endocarditis, acute nephritis; benzyl alcohol products in neonates/infants/pregnancy/lactation
54
Heparin | Side Effects
CNS: Fever, chills, headache GU: HEMATURIA HEMA: HEMORRHAGE, THROMBOCYTOPENIA, ANEMIA INTEG: Rash, dermatitis, urticaria, pruritus, delayed transient alopecia, hematoma, cutaneous necrosis (SUBCUT) META: hyperkalemia, hypoaldosteronism SYST: ANAPHYLAXIS
55
Heparin | Nursing Considerations
ASSESS: - Bleeding, hemorrhage: gums, petechiae, ecchymosis, black tarry stools, hematuria, epistaxis, decrease in Hct, BP; HIT may occur after product discontinuation - Blood studies (Hct, occult blood in stools) q3mo - Partial prothrombin time, which should be 1.5-2.5x control; for continuous IV inf, check aPTT baseline 6hr after initiation and 6hr after any dose change; use aPTT for dosing adjustments; after therapeutic aPTT has been measured 2x, check aPTT daily - Platelet count q2-3days; thrombocytopenia may occur on 4th day of treatment - HYPERSENSITIVITY: rash, chills, fever, itching; report to prescriber
56
Heparin | Overdose Treatment
Withdraw product, protamine 1mg protamine/100 units heparin
57
Warfarin (Coumadin) | Functional Classification
Anticoagulant
58
Warfarin (Coumadin) | Chemical Classification
Coumarin derivative
59
Warfarin (Coumadin) | Mechanism of Action
Interferes with blood clotting by indirect means; depresses hepatic synthesis of vit-K-dependent coagulation factors (II, VII, IX, X)
60
Warfarin (Coumadin) | Uses
Antiphospholipid antibody syndrome, arterial thromboembolism prophylaxis, DVT, MI prophylaxis, after MI, stroke prophylaxis, thrombosis prophylaxis
61
Warfarin (Coumadin) | Contraindications
Pregnancy (X), breastfeeding, hypersensitivity, hemophilia, leukemia with bleeding, peptic ulcer disease, thrombocytopenic purpura, hepatic disease (severe), malignant hypertension, subacute bacterial endocarditis, acute nephritis, blood dyscrasias, eclampsia, preeclampsia, hemorrhagic tendencies; surgery of CNS, eye; traumatic surgery with large open surface, bleeding tendencies of GI/GU/respiratory tract, stroke, aneurysms, pericardial effusion, spinal puncture, major regional/lumbar anesthesia Bleeding
62
Warfarin (Coumadin) | Side Effects
CNS: Fever, dizziness, fatigue, headache, lethargy CV: angina, chest pain, edema, hypotension, syncope GI: Diarrhea, nausea, vomiting, anorexia, stomatitis, cramps, HEPATITIS, cholestatic jaundice GU: HEMATURIA HEMA: HEMORRHAGE, AGRANULOCYTOSIS, LEUKOPENIA, EOSINOPHILIA, anemia, ecchymosis, petechiae INTEG: Rash, dermatitis, urticaria, alopecia, pruritus MISC: epistaxis, hemoptysis, mouth ulcers, taste disturbances, priapism, dyspnea MS: bone fractures SYST: ANAPHYLAXIS, coma, cholesterol, microembolism, EXFOLIATIVE DERMATITIS, PURPLE TOE SYNDROME
63
Warfarin (Coumadin) | Nursing Considerations
ASSESS: - Blood studies (Hct, PT, platelets, occult blood in stools) q3mo; INR: in hospital daily after 2nd or 3rd dose; when in therapeutic range for 2 consecutive days, monitor 2-3x wk for 1-2wk then less frequently, depending on stability of INR results; Outpatient: monitor every few days until stable doses then periodically thereafter, depending on stability of INR results - Bleeding gums, petechiae, ecchymosis, black tarry stools, hematuria; fatal hemorrhage can occur - Fever, skin rash, urticaria
64
Warfarin (Coumadin) | Overdose Treatment
Administer vit K
65
Alteplase (tissue plasminogen activator, t-Pa) | Functional Classification
Thrombolytic enzyme

ATI: PHARM 2 - (Drug Classes) (40 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions